The long road to medical treatment in Uganda

Getting sick and having to be hospitalized is a frightening experience for anyone. Feeling anxious, uncertain and maybe even helpless is common even among people living in the most developed countries on Earth. Now, imagine this: you or your child gets sick. You don’t have health insurance. The nearest hospital is a long way away. Sounds pretty bad, right? Now imagine you were living in Uganda, a country ranked 186^th of 191 World Health Organization countries in terms of its health care performance. This was the situation Rachel (names have been changed for privacy), a 34-year old mother of eight, whose husband is a matatu (urban minibus) driver, found herself in some time ago.

Exploring healthcare and insurance in Uganda
We met Rachel in early 2014 when Women’s World Banking undertook customer research in partnership with our local network member Finance Trust Bank (FTB).  FTB and Women’s World Banking are working together to develop and offer a health microinsurance product to help alleviate the financial burden of major illness for their low-income clients. We began our product development work as all Women’s World Banking projects do: with in-depth market research. In order to create financial products tailored to a specific market, we must first understand their lives, needs and aspirations. Specifically in Uganda, we needed to understand the usage, needs, financing and costs for healthcare among low-income people, as well as their awareness of insurance. We heard dozens of stories of the healthcare struggles that are standard for low-income Ugandans, stories that will then help shape product design and implementation strategies for FTB’s microinsurance product. Rachel’s story is, sadly, typical.

The long road to healthcare
One day, Rachel’s youngest son Okello started feeling sick. Since the incidence of malaria in Uganda is extremely high (almost 10% of deaths are due to malaria), Rachel and her husband first assumed that the baby had malaria and gave him some quinine tablets, a standard treatment familiar to all Ugandans. The medicine had no effect so when his condition worsened a few days later, they took him to a small local clinic where the doctors diagnosed him with typhoid fever. He was admitted and put on an intravenous drip for two days. After seeing no improvement and lacking the facilities to treat severe cases at the clinic, the doctors referred him to a private hospital in another city. Rachel knows that private hospitals are expensive and worried that they would not be able to afford the cost of treatment in this new place, but she wanted to try to give her child the best care possible.

When they got to the private hospital, the doctors asked the family to pay USh 15,000 (US$6) for a blood test to confirm the typhoid fever diagnosis. She was then told that admission to the hospital would be USh 110,000 (US$44), but in a country where the average monthly income is US$ 68[1], this sum was out of reach. So off they went again until they found a government hospital where Okello could be admitted at a lower cost. He had gotten so weak at this point that the doctors immediately ordered blood transfusions, something that would have been relatively inexpensive had Rachel and her husband been a match. They were not. They had to go to a clinic two hours away from the hospital to buy blood.

Slowly, Okello started to recover and they were able to go back home a few days later. All in all, the process of getting proper medical treatment took three weeks and four different health care facilities. Between medical costs and transportation back and forth from the different health centers, it cost Rachel over USh 300,000 (US$120)[2]—the equivalent of two months’ income. This sum doesn’t take into account the family’s lost income over that period. Rachel paid for the treatment using the family’s savings and a microfinance loan her husband had just received, de-capitalizing the family business and putting their means of income in jeopardy… a situation that pushed them further into economic insecurity.

The promise of microinsurance
Because fewer than 1% of Ugandans have health insurance, Rachel’s story reflects the uncertainty, stress and anxiety that a great many Ugandans face every time they have a health problem. FTB, with the support of Women’s World Banking is developing a health microinsurance product to help alleviate this stress and promote better health outcomes for its clients. The product will be modeled after Caregiver, Women’s World Banking’s hospital-cash product. It has had great success in Jordan with network member Microfund for Women (MFW) and we are working to introduce Caregiver in other countries. Nearly 200,000 of MFW’s clients have been insured to date and more than 8,500 claims have been paid out. Furthermore, the institution has seen an increase in its client retention and interest from new clients who come to MFW after hearing good stories from current policyholders. We are hoping for similar success with Caja Arequipa in Peru with the product named Familia Segura or “Safe Family” (a product profiled in this previous post).

Most Ugandans have no safety net to help manage health expenses, which are largely unknown until treatment ends (We will delve into the ‘tip of the iceberg’ phenomenon in the next post). Thus, many often try to ignore symptoms, use alternative medicines or delay treatment until the health problems become too serious to be ignored. A Caregiver product adapted to the conditions of Uganda has the potential to be a strong win for both the microfinance institution and partner insurer, while helping clients and their families relieve the stress and uncertainty of grave illness by giving them a shorter, more reliable path toward healthcare.

This project benefits from the Agence Française de Développement support. The analysis, views and opinions expressed are those of the author and do not necessarily reflect the position of the Agence Française de Développement.